Healthcare-Associated

Infection Surveillance

Indonesia
December 18, 2012

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 What is surveillance?

 Continuous systematic collection of data on illness in a

defined population

 Uses standard definitions for the outcome of interest;

e.g., infection, sharps injuries, employee illness

 Involves analysis, interpretation, & dissemination of

data for the purpose of improving health & preventing
disease

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 Surveillance
 Active surveillance
– Proactive approaches such
• Concurrent monitoring of the patients with a
central line and urinary catheter and/or on the
ventilator
• Reviewing important culture results generated by
various microbiology laboratories (local, regional,
national, and international) daily
• Walk-around or surveillance rounds
• Surveillance cultures of targeted patients to plan

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a preemptive IPC plans: Examples-MRSA,
MDROs.
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 Surveillance
 Active surveillance (cont’d)
 Reviewing daily census in AM
 Environment of Care (EOC) rounds
 Hand hygiene compliance monitoring
 Reviewing all patients in isolation
 Outbreak/exposure investigation
 Construction Risk Assessment before

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construction begins

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 Surveillance
 Passive surveillance
• Retroactive activities such as,
• reviewing medical records, culture results
(wound, blood, urine, etc.), various reports
(SSI summary after discharge, water tests,
sterilization indicators, sharps injury rates,
etc..)
• surgical antibiotic prophylaxis (see antibiotic

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stewardship)

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 Surveillance Strategy

 Risk-based
 Unit-based
 Pathogen-based
 Procedure-based

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 Surveillance Methods

1. Total or universal surveillance

2. Targeted or focused surveillance

3. Prevalence survey

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When to use a targeted surveillance?

 High risk infections

 High volume procedures
 Preventable adverse outcomes
 Critical processes
 Infection rates pertain to specific devices, procedures,
care processes, employee issues

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 Large patient population and limited resources

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 Electronic Surveillance

 Data Mining – detect patterns and likely infections or

outbreaks; uses clinical, pharmacological, laboratory
data

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 Collecting Data
 Definition of healthcare-associated infection related
with each target condition or area
 Review medical records
 Clinical symptoms and signs compatible with an
infection
 Conference with clinicians, nurses, and others
 Review medical records
 Confirm HAI
 Documentation
 Tabulation and analysis
 Reporting

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 Follow up

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Numerator, Denominator, and Multiplier

½ X 1,000

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 Denominators

 Population at risk
 Patient days / residents days
 Device days
– central line days
– ventilator days
– Foley catheter days UTI
 Procedures performed 5 infections/1,000 device days
 # patients discharged
CLABSI
10 infections/1,000 line days

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 Numerators

 HAI cases-SSI, VAP, CLABSI, etc.

 Positive blood cultures
 Positive VRE in stool
 Positive MRSA in nares/axilla/groin
 Patients on vancomycin

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 Analyzing Data

 Incidence = new cases x constant (1000)

population at risk

 Prevalence = existing cases x constant

population at risk

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Risk Stratification-Risk Adjustment

Surgical Site Infections

 Patients have different risks for acquiring HAI
– Host factor
– Preexisting risks (comorbidities, ASA score, etc.)
– Intra-operative variables (duration of surgery,
bleeding, body temperature, oxygenation, etc.)
– Sample size (too small)

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Standardized Infection Rate (SIR)
 Standardized Infection Rate (SIR)
= Observed SSI rate / SSI rate of standard population
(average rate)
OR
= Observed SSI number / Expected SSI number
 Example.
– Dr. Z’s SSI for cholecystectomy: 6
– Expected SSI in the standard population: 1.16

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SIR = 6/1.16 = 5.2* (> 1)
*Sample size may require Z-test

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 Collecting and Documenting Data
 Narrative
– E.g; A 34 year old male underwent an open
repair and internal fixation of right ankle
fracture. The wound became infected 5 days
later with S. aureus.
• Old fashioned?
• Difficult to aggregate at the end of the
surveillance

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• No visual impact

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 Collecting Data
 Graphic analytical analysis
– Bar graph

– Line graph

– Pie graph

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 Measles

5 Index case
First generation case
4 Second generation case
Cases

3 Third generation case

2
1
0
14 3

20 9
23 2
26 5

17 6
17 6

14 3

9
-1
11 0

10
4
7

7
4
-1

-1
-2
-2

-1
-1

-2

-1

-1
1
2-
5-

5-
2-
29
8-

8-

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September October
Date of Onset
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 Blood Stream Infection Rates

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 Surgical Site Infection Rates

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 BSI Rate and Intervention

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 Collecting Data; data sheet
 Computer soft ware
– Excel sheet

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 Collecting Data; Dashboard

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Collecting Data:Dashboard with Trends

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 Data Analysis and Use

 Timely
 Share the data
 Learn from it
 Plan for improvement

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